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Published online by Cambridge University Press:  15 April 2011

Michelle van Ryn*
Department of Family Medicine and Community Health, University of Minnesota
Diana J. Burgess
Center for Chronic Disease Outcomes Research, Minneapolis VA Medical Center and Department of Medicine, University of Minnesota.
John F. Dovidio
Department of Psychology, Yale University
Sean M. Phelan
Department of Family Medicine and Community Health, University of Minnesota
Somnath Saha
Section of General Internal Medicine, Portland VA Medical Center and Division of General Internal Medicine and Geriatrics, Oregon Health and Science University
Jennifer Malat
Department of Sociology, University of Cincinnati
Joan M. Griffin
Center for Chronic Disease Outcomes Research, Minneapolis VA Medical Center and Department of Medicine, University of Minnesota
Steven S. Fu
Center for Chronic Disease Outcomes Research, Minneapolis VA Medical Center and Department of Medicine, University of Minnesota
Sylvia Perry
Department of Psychology, Yale University
Michelle van Ryn, Department of Family Medicine and Community Health, University of Minnesota Medical School, Room 221, 925 Delaware Street SE, Minneapolis, MN 55414. E-mail:


Over the past two decades, thousands of studies have demonstrated that Blacks receive lower quality medical care than Whites, independent of disease status, setting, insurance, and other clinically relevant factors. Despite this, there has been little progress towards eradicating these inequities. Almost a decade ago we proposed a conceptual model identifying mechanisms through which clinicians' behavior, cognition, and decision making might be influenced by implicit racial biases and explicit racial stereotypes, and thereby contribute to racial inequities in care. Empirical evidence has supported many of these hypothesized mechanisms, demonstrating that White medical care clinicians: (1) hold negative implicit racial biases and explicit racial stereotypes, (2) have implicit racial biases that persist independently of and in contrast to their explicit (conscious) racial attitudes, and (3) can be influenced by racial bias in their clinical decision making and behavior during encounters with Black patients. This paper applies evidence from several disciplines to further specify our original model and elaborate on the ways racism can interact with cognitive biases to affect clinicians' behavior and decisions and in turn, patient behavior and decisions. We then highlight avenues for intervention and make specific recommendations to medical care and grant-making organizations.

Unpacking Racism and its Health Consequences
Copyright © W.E.B. Du Bois Institute for African and African American Research 2011

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